| NPI | 1053164723 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAROLD J BLACKWELL Owner 346-702-8387 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-04-10 |